Knee orthopaedics and trauma Flashcards Preview

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Flashcards in Knee orthopaedics and trauma Deck (50)
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31

What are the complications associated with total knee dislocation?

Popliteal artery injury (tear, intimal tera & thrombosis)
 Nerve injury – common peroneal nerve
Compartment syndrome

Tear of all four ligaments

 

32

Why must regular foot examinations be undertaken following a total knee dislocation?

Intimal tears may occur causing thrombosis

Vascular status of foot must be monitored

33

What is the treatment for total knee dislocation?

Emergency reduction

External fixation for stabilisation

Mulitple ligament reconstruction

34

What can cause an osteochondral injury?

 Impaction or shear of the articular surfaces or due to a direct blow

35

What investigations should be done for suspected osteochondral injury?

Xray
MRI

Arthroscopy

36

How should acute injuries with large oestochondral fragments and substantial amounts of bone be managed?

Fixation with pins

37

What management option is availiable If a defect due to osteochondral injury has bare bone at its base?

Microfracture - holes can be drilled into the defect to induce bleeding and encourage formation of fibrocartilidge, scar type hyaline cartilidge, to repair the defect

38

What are the components of the extensor mechanism of the knee?

Tibial tuberosity

Patellar tendon,

Patella

Quadriceps tendon

Quadriceps muscles

39

What are some predisposing factors to development of extensor mechanism rupture?

History of tendonitis

Chronic steroid use or abuse (body builders)

Diabetes

Rheumatoid arthritis

Chronic renal failure

40

What kind of injuries can cause ruputre of the patellar tendon or the quadriceps tendon?

Rapid contractile force which can occur after lifting a heavy weight, after a fall or spontaneously in a severely degenerate tendon

41

Which patients are more likely to have patellar or quadriceps tendon rupture?

Younger - patellar tendon (<40)

Older - quadriceps tendon (>40)

42

Why should steroid injections for tendonitis of extensor mechanism be avoided?

High predisposition to tendon rupture

43

What signs might extensor mechanism rupture show on examination?

Difficulty with straight leg raise test

Palpable gap in extensor mechanism

44

How might extensor mechanism rupture show on Xray?

Low lying patella (quadriceps tendon rupture)

High lying patella (patellar tendon rupture)

45

What is patellofemoral dysfunction?

 It describes disorders of the patellofemoral articulation resulting in anterior knee pain

46

What are some of the symptoms of patellofemoral dysfuncton?

Anterior knee pain - worse going downhill

'Clicking' or grinding sensation at front of knee

Stiffness after prologned sitting causing psuedolocking

47

What are some predisposing factors to patellofemoral dysfunction?

Female

Adolescence

Femoral neck anteversion

Genu valgum

Joint hypermobility

48

What can cause the anterior knee pain in patellofemoral dysfunction?

The pull of the quadriceps muscle tends to pull the patella in a slight lateral direction: in some people, excessive lateral force produces anterior knee pain and the lateral facet of the patella is compressed against the lateral wall of the distal femoral trochlea

Chondromalacia patellae (softening of the hyaline cartilage)

49

What is the treatment for patellofemoral dysfunction?

Physiotherapy

Surgery as a last resort - either releasing a tight lateral retinaculum or if there is a relatively lateralized tibial tubercle, a tibial tubercle transfer to aid patellar trackin

50

Which way does the patella tend to dislocate?

Laterally